1
|
Nguyen D, Liu Y, Kavanagh SA, Archibald D. Gender-sensitive community weight-loss programmes to address overweight and obesity in men: a scoping review. BMJ Open 2024; 14:e083646. [PMID: 38991680 PMCID: PMC11243212 DOI: 10.1136/bmjopen-2023-083646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES To examine how gender-sensitive community weight-loss programmes have been used to address overweight and obesity in men and to identify what can be learnt from this rapidly evolving field. DESIGN Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist for reporting. DATA SOURCES A database search was conducted using EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition and Medline Complete), Google, Google Scholar, Open Access Theses and Dissertations platform and Scopus. ELIGIBILITY CRITERIA All weight-loss programmes using a gender-sensitive approach to address men's overweight and obesity in community settings. DATA EXTRACTION AND SYNTHESIS Narrative synthesis was conducted based on the research questions and objectives. Primary outcomes include operationalisation, context and concept of the gender-sensitive approach. Information was reviewed and extracted to Microsoft Excel by two reviewers. RESULTS A total of 40 studies (28 quantitative, eight mixed methods and four qualitative) were identified from 4617 records. Gender-sensitive approaches were undertaken in a range of settings and contexts including professional sports clubs (n=21), non-professional sporting clubs (n=16), workplace-based (n=2) and commercial organisation-based (n=1). The most common analysis approaches were evaluating the effect of the programmes (n=31) where positive impact was predominantly shown (eg, up to 3.9 kg weight reduction at 3-month follow-up). Programmes (ie, Football Fans in Training) were short-term cost-effective (eg, the cost was £862-£2228 per 5% weight reduction at 12-month follow-up). Qualitative evidence highlights factors that influenced men's participation (eg, camaraderie) and identifies areas for improvement. CONCLUSION The findings demonstrate that gender-sensitive programmes for men's weight loss have been effectively applied using a range of different approaches and in a range of different contexts. Further evidence is needed to confirm the effectiveness of the programmes across diverse groups of men.
Collapse
Affiliation(s)
- Dieu Nguyen
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Victoria, Australia
| | - Yutong Liu
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Victoria, Australia
| | - Shane A Kavanagh
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Victoria, Australia
| | - Daryll Archibald
- La Trobe University, Olga Tennison Autism Research Centre, Bundoora, Victoria, Australia
| |
Collapse
|
2
|
Le LKD, Tan EJ, Hay P, Ananthapavan J, Lee YY, Mihalopoulos C. The Modeled Cost-Effectiveness of a Prevention Program Targeting Both Eating Disorders and High BMI. Int J Eat Disord 2024. [PMID: 38975786 DOI: 10.1002/eat.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/18/2024] [Accepted: 05/22/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost-effective. This study aims to determine the cost-effectiveness of an intervention that aims to prevent both ED and high BMI. METHOD A Markov model was developed to evaluate the incremental cost-effectiveness of a targeted school-based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15-18 years), versus a "no intervention" comparator. A cost-utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. RESULTS The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83-2.43 million) and 146 (95% CI, 90-209), respectively. With healthcare cost-savings (AUD$3.97 million) included, the intervention was predicted to be cost-saving (AUD$1.83 million; 95% CI, AUD$0.51-3.21 million). Primary findings were robust to extensive sensitivity analyses. DISCUSSION The Healthy Weight intervention is likely to represent good value-for-money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required.
Collapse
Affiliation(s)
- Long Khanh-Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Camden and Campbelltown Hospital, SWSLHD, Campbelltown, New South Wales, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Yong Yi Lee
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kaló Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt. J Egypt Public Health Assoc 2024; 99:12. [PMID: 38825614 PMCID: PMC11144683 DOI: 10.1186/s42506-024-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
Collapse
Affiliation(s)
- Ahmad N Fasseeh
- Faculty of Pharmacy Alexandria University, Alexandria, Egypt
- Syreon Middle East, Alexandria, Egypt
| | | | | | - Amal S Sedrak
- Department of Public Health, Cairo University, Cairo, Egypt
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Randa Eldessouki
- Department of Community Health, Fayoum University, Fayoum, Egypt
| | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Ahmed Y Khalifa
- World Health Organization Representative Office, Cairo, Egypt
| | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| |
Collapse
|
4
|
Rozga M, Handu D. Nutrition Interventions for Pediatric Obesity Prevention: An Umbrella Review of Systematic Reviews. Nutrients 2023; 15:5097. [PMID: 38140356 PMCID: PMC10745722 DOI: 10.3390/nu15245097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Nutrition interventions to prevent pediatric obesity can help to establish healthy habits to improve current and future health. The objective of this umbrella review of systematic reviews (SRs) is to examine the impact of obesity prevention interventions with a nutrition component on body mass index measures, overweight/obesity prevalence, and cost-effectiveness in participants 2-17 years old. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used, and this umbrella review was registered on PROSPERO (CRD42023443033). Included SRs were required to search ≥2 databases and to assess the risk of bias (RoB) of primary studies, and they were published 2017-June 2023. Database searches identified 4776 articles, and 31 SRs were included. In all age groups combined, interventions with both nutrition and physical activity were effective and cost-effective in all settings combined, and in the community setting specifically. In children ≤5 years old, interventions in the home and family, community, and healthcare settings demonstrated some efficacy, whereas in children 6-12 years old, school interventions were most effective. Evidence with individuals 13-17 years was limited. The certainty of evidence was generally low due to RoB in included studies, inconsistency, and imprecision. Pediatric obesity prevention interventions with nutrition should be tailored to the developmental stage to ensure appropriateness and efficacy.
Collapse
Affiliation(s)
- Mary Rozga
- Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995, USA;
| | | |
Collapse
|
5
|
Huse O, Backholer K, Nguyen P, Calibo A, Guirindola M, Desnacido JP, Sacks G, Bell AC, Peeters A, Angeles-Agdeppa I, Ananthapavan J. A comparative analysis of the cost-utility of the Philippine tax on sweetened beverages as proposed and as implemented. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100912. [PMID: 37780636 PMCID: PMC10534259 DOI: 10.1016/j.lanwpc.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
Background In response to increasing overweight and obesity, the Philippine government introduced a tax on sweetened beverages (SBs) in 2018. Evidence suggests that the beverage industry influenced the final tax design, making it more favourable for industry than the initially proposed bill. This study aimed to compare the relative health and economic benefits of the proposed SB tax with the implemented SB tax. Methods Philippine dietary consumption data were combined with price elasticity data from Mexico and data from Australia adapted to the Philippine context to estimate reductions in SB purchases and changes in body mass index (BMI) following the implementation of the tax. A multi-state, multiple-cohort Markov model was used to estimate the change in health-adjusted life years (HALYs) due to reduction in the epidemiology of obesity-related diseases, healthcare cost savings and government taxation revenue, resulting from both the proposed and implemented tax policies, over the lifetime of the 2018 Philippine population. Findings The proposed and implemented taxes were modelled to be dominant (cost-saving and improving health). Intervention costs were modelled to be PHP305.2 million (M) (approximately US$6M). Compared to the proposed tax, the implemented tax was modelled to result in a 43.0% smaller reduction in targeted beverage intake (51.1 ml/person/day vs. 89.7 ml/person/day), a 43.5% smaller reduction in BMI (0.35 kg/m2 vs. 0.62 kg/m2), 39.7% fewer HALYs gained (2,503,118 vs. 4,149,030), 39.9% fewer healthcare cost savings (PHP16.4 billion (B) vs. PHP27.3B), and 27.7% less government taxation revenue (PHP426.3B vs. PHP589.4B). Interpretation While the implemented tax in the Philippines will benefit population health, it is likely to yield less benefit than the proposed tax. The influence of the food and beverage industry on policy processes has the potential to lessen the benefits of population NCD prevention policies. Funding OH was supported to conduct this research by an Australian Government Research Training Program Stipend Scholarship. The funding body had no role in data collection and analysis, or manuscript preparation.
Collapse
Affiliation(s)
- Oliver Huse
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anthony Calibo
- Child Health Division, Department of Health, Medical Specialist IV, Disease Prevention and Control Bureau, Manila (2011-2020), Philippines
- Institute of Pediatrics and Child Health, St. Luke's Medical Center, Quezon City, Philippines
| | - Mildred Guirindola
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Josie P. Desnacido
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Gary Sacks
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Andrew Colin Bell
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Jaithri Ananthapavan
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| |
Collapse
|
6
|
Guarino M, Matonti L, Chiarelli F, Blasetti A. Primary prevention programs for childhood obesity: are they cost-effective? Ital J Pediatr 2023; 49:28. [PMID: 36864472 PMCID: PMC9983264 DOI: 10.1186/s13052-023-01424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023] Open
Abstract
Childhood obesity is increasing all over the world. It is associated with a reduction in quality of life and a relevant burden on society costs. This systematic review deals with the cost-effectiveness analysis (CEA) of primary prevention programs on childhood overweight/obesity, in order to benefit from cost-effective interventions.We screened and evaluated all the studies with a cost-effectiveness analysis on childhood obesity primary prevention program by PUBMED and Google Scholar, using inclusion and exclusion criteria. The quality of the studies was assessed by Drummond's checklist.Ten studies were included. Two of them examined the cost-effectiveness of community-based prevention programs, four focused only on school-based programs while four more studies examined both community-based and school-based programs. The studies were different in terms of study design, target population, health and economic outcomes. Seventy per cent of the works had positive economic results.The majority of the studies showed effective economic outcomes applying primary prevention programs on childhood obesity. It is important to increase homogeneity and consistency among different studies.
Collapse
Affiliation(s)
| | - Lorena Matonti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Francesco Chiarelli
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Annalisa Blasetti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| |
Collapse
|
7
|
Ananthapavan J, Tran HNQ, Morley B, Hart E, Kennington K, Stevens-Cutler J, Bowe SJ, Crosland P, Moodie M. Cost-effectiveness of LiveLighter® - a mass media public education campaign for obesity prevention. PLoS One 2022; 17:e0274917. [PMID: 36129952 PMCID: PMC9491524 DOI: 10.1371/journal.pone.0274917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background The Western Australian LiveLighter® program has implemented a series of mass media advertising campaigns that aim to encourage adults to achieve and maintain a healthy weight through healthy behaviours. This study aimed to assess the cost-effectiveness of the LiveLighter® campaign in preventing obesity-related ill health in the Western Australian population from the health sector perspective. Methods Campaign effectiveness (delivered over 12 months) was estimated from a meta-analysis of two cohort studies that surveyed a representative sample of the Western Australian population aged 25–49 years on discretionary food consumption one month pre- and one month post-campaign. Campaign costs were derived from campaign invoices and interviews with campaign staff. Long-term health (measured in health-adjusted life years (HALYs)) and healthcare cost-savings resulting from reduced obesity-related diseases were modelled over the lifetime of the population using a validated multi-state lifetable Markov model (ACE-Obesity Policy model). All cost and health outcomes were discounted at 7% and presented in 2017 values. Uncertainty analyses were undertaken using Monte-Carlo simulations. Results The 12-month intervention was estimated to cost approximately A$2.46 million (M) (95% uncertainty interval (UI): 2.26M; 2.67M). The meta-analysis indicated post-campaign weekly reduction in sugary drinks consumption of 0.78 serves (95% UI: 0.57; 1.0) and sweet food of 0.28 serves (95% UI: 0.07; 0.48), which was modelled to result in average weight reduction of 0.58 kilograms (95%UI: 0.31; 0.92), 204 HALYs gained (95%UI: 103; 334), and healthcare cost-savings of A$3.17M (95%UI: A$1.66M; A$5.03M). The mean incremental cost-effectiveness ratio showed that LiveLighter® was dominant (cost-saving and health promoting; 95%UI: dominant; A$7 703 per HALY gained). The intervention remained cost-effective in all sensitivity analyses conducted. Conclusion The LiveLighter® campaign is likely to represent very good value-for-money as an obesity prevention intervention in Western Australia and should be included as part of an evidence-based obesity prevention strategy.
Collapse
Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Huong Ngoc Quynh Tran
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Ellen Hart
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Kelly Kennington
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | | | - Steven J. Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Paul Crosland
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
8
|
Tran HNQ, Killedar A, Tan EJ, Moodie M, Hayes A, Swinburn B, Nichols M, Brown V. Cost-effectiveness of scaling up a whole-of-community intervention: The Romp & Chomp early childhood obesity prevention intervention. Pediatr Obes 2022; 17:e12915. [PMID: 35301814 PMCID: PMC9540361 DOI: 10.1111/ijpo.12915] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Given the high prevalence of early childhood overweight and obesity, more evidence is required to better understand the cost-effectiveness of community-wide interventions targeting obesity prevention in children aged 0-5 years. OBJECTIVES To assess the cost-effectiveness of the Romp & Chomp community-wide early childhood obesity prevention intervention if delivered across Australia in 2018 from a funder perspective, against a no-intervention comparator. METHODS Intervention costs were estimated in 2018 Australian dollars. The annual Early Prevention of Obesity in Childhood micro-simulation model estimated body mass index (BMI) trajectories to age 15 years, based on end of trial data at age 3.5 years. Results from modelled cost-effectiveness analyses were presented as incremental cost-effectiveness ratios (ICERs): cost per BMI unit avoided, and cost per quality-adjusted life year (QALY) gained at age 15 years. RESULTS All Australian children aged 0-5 years (n = 1 906 075) would receive the intervention. Total estimated intervention cost and annual cost per participant were AUD178 million and AUD93, respectively, if implemented nationally. The ICERs were AUD1 126 per BMI unit avoided and AUD26 399 per QALY gained (64% probability of being cost-effective measured against a AUD50 000 per QALY threshold). CONCLUSIONS Romp & Chomp has a fair probability of being cost-effective if delivered at scale.
Collapse
Affiliation(s)
- Huong Ngoc Quynh Tran
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Anagha Killedar
- Faculty of Medicine and Health, School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Eng Joo Tan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Alison Hayes
- Faculty of Medicine and Health, School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,School of Population Health, University of AucklandAucklandNew Zealand
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| |
Collapse
|
9
|
Whelan J, Hayward J, Nichols M, Brown AD, Orellana L, Brown V, Becker D, Bell C, Swinburn B, Peeters A, Moodie M, Geddes SA, Chadwick C, Allender S, Strugnell C. Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND): protocol and baseline outcomes for a stepped-wedge cluster-randomised prevention trial. BMJ Open 2022; 12:e057187. [PMID: 36581987 PMCID: PMC9438198 DOI: 10.1136/bmjopen-2021-057187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Systems science methodologies have been used in attempts to address the complex and dynamic causes of childhood obesity with varied results. This paper presents a protocol for the Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND) trial. RESPOND represents a significant advance on previous approaches by identifying and operationalising a clear systems methodology and building skills and knowledge in the design and implementation of this approach among community stakeholders. METHODS AND ANALYSIS RESPOND is a 4-year cluster-randomised stepped-wedge trial in 10 local government areas in Victoria, Australia. The intervention comprises four stages: catalyse and set up, monitoring, community engagement and implementation. The trial will be evaluated for individuals, community settings and context, cost-effectiveness, and systems and implementation processes. Individual-level data including weight status, diet and activity behaviours will be collected every 2 years from school children in grades 2, 4 and 6 using an opt-out consent process. Community-level data will include knowledge and engagement, collaboration networks, economic costs and shifts in mental models aligned with systems training. Baseline prevalence data were collected between March and June 2019 among >3700 children from 91 primary schools. ETHICS AND DISSEMINATION Ethics approval: Deakin University Human Research Ethics Committee (HREC 2018-381) or Deakin University's Faculty of Health Ethics Advisory Committee (HEAG-H_2019-1; HEAG-H 37_2019; HEAG-H 173_2018; HEAG-H 12_2019); Victorian Government Department of Education and Training (2019_003943); Catholic Archdiocese of Melbourne (Catholic Education Melbourne, 2019-0872) and Diocese of Sandhurst (24 May 2019). The results of RESPOND, including primary and secondary outcomes, and emerging studies developed throughout the intervention, will be published in the academic literature, presented at national and international conferences, community newsletters, newspapers, infographics and relevant social media. TRIAL REGISTRATION NUMBER ACTRN12618001986268p.
Collapse
Affiliation(s)
- Jillian Whelan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Joshua Hayward
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Andrew D Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Denise Becker
- Biostatistics Unit, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Anna Peeters
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Sandy A Geddes
- Department of Health and Human Services, State Government of Victoria, Melbourne, Victoria, Australia
| | - Craig Chadwick
- Goulburn Valley Primary Care Partnership, Shepparton, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
10
|
Strugnell C, Crooks N, Gaskin CJ, Becker D, Orellana L, Bolton KA, Fraser P, Brown AD, Le H, Bell C, Allender S. Four-Year Accelerometry Outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity. Child Obes 2022. [PMID: 35930254 DOI: 10.1089/chi.2022.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: We investigated the effect of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) intervention on children's objectively measured physical activity and sedentary time (ST). Methods: We conducted a cluster randomized controlled trial with children in grades 4 (∼9-10 years old) and grade 6 (∼11-12 years old) from 10 communities in the Great South Coast region of Victoria, Australia. Communities were randomly allocated (1:1) to receive the WHO STOPS intervention in 2015. WHO STOPS was a whole of community systems-based approach to preventing childhood obesity. Outcome data were collected using a repeat cross-sectional design in 2015, 2017, and 2019. Children were asked to wear a hip-mounted accelerometer for 7 days. Age-specific Axis 1 activity counts were converted into duration (minutes/day) spent engaged in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and ST. Linear mixed regression models were fitted to estimate the effects of the intervention on the three activity outcomes across the study period. Results: Analyses were based on valid accelerometer data from 1406 children (intervention n = 745; control n = 661). Results for MVPA, LPA, and ST were nonsignificant. Between 2015 and 2017, there were positive, but nonsignificant, changes in mean MVPA favoring intervention boys [3.7 minutes/day; 95% confidence interval (CI): -5.7 to 13.1] and girls (5.5 minutes/day; 95% CI: -1.5 to 12.6). By 2019, these effects had attenuated. Conclusions: Although the WHO STOPS intervention did not significantly change activity levels, the magnitudes of the effects on MVPA suggest that further research with whole-of-community interventions in larger samples would be worthwhile. Clinical trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR.org.au) identifier 12616000980437.
Collapse
Affiliation(s)
- Claudia Strugnell
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Nic Crooks
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Cadeyrn J Gaskin
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Denise Becker
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Kristy A Bolton
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Penny Fraser
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Andrew Dwight Brown
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Ha Le
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Obesity Center (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
11
|
Wolker Manta S, Fabrício Sandreschi P, Christofoletti Dos Santos M, Maria Konrad L, Miranda Tassitano R, Rosane Bertoldo Benedetti T. Barriers and facilitators on the implementation of physical activity in Primary Health Care: A systematic review. Prev Med Rep 2022; 28:101875. [PMID: 35813399 PMCID: PMC9260606 DOI: 10.1016/j.pmedr.2022.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/05/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022] Open
Abstract
Barriers and facilitators influence the implementation of physical activity (PA) in Primary Health Care (PHC). This study aimed to analyze the scientific evidence on barriers and facilitators perceived by stakeholders on the implementation of PA in PHC.The search databases consisted of Web of Science, Medline, Scopus, and Lilacs. Two independent researchers reviewed the eligibility criteria and extracted and coded the information according to the Theoretical Domains Framework (TDF). The Consolidated Criteria for Reporting Qualitative Research was used to report the quality of the included studies. We analyzed 8.471 studies but included only 16. The studies identified 54 different reports on barriers and 48 on facilitators. Reports were often identified in the "environmental context and resources" domain, with 27 reports on barriers and 27 on facilitators. We found 25 reports of barriers and 16 of facilitators in the TDF domains that demonstrate professional profile characteristics. The low expectations in the professional profile for the implementation can influence the context and the organizational climate to identify more barriers than facilitators.
Collapse
|
12
|
Maple JL, Ananthapavan J, Ball K, Teychenne M, Moodie M. Economic evaluation of an incentive-based program to increase physical activity and reduce sedentary behaviour in middle-aged adults. BMC Health Serv Res 2022; 22:932. [PMID: 35854379 PMCID: PMC9297637 DOI: 10.1186/s12913-022-08294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incentive-based programs represent a promising approach for health insurers to encourage health-promoting behaviours. However, little is known about the value for money of such programs. This study aimed to determine the cost-effectiveness of the ACHIEVE (Active CHoices IncEntiVE) program designed to incentivise increased physical activity and reduced sedentary behaviour in middle-aged adults. METHODS A within-trial cost-efficacy analysis was conducted. Benefits were assessed by evaluating paired t-tests from participants' pre- and post- trial Body Mass Index (BMI) (kg/m2), sitting time (minutes/day) and metabolic equivalents (METS) minutes. A health sector perspective was adopted for the assessment of costs. Pathway analysis was used to determine the resource use associated with the intervention, with costs expressed in Australian dollars (A$) for the 2015 reference year. A long-term cost-effectiveness analysis was undertaken which extended the analysis time horizon and the trial population to the relevant eligible Australian population. Within this analysis, the 16-week intervention was modelled for roll-out across Australia over a 1-year time horizon targeting people with private health insurance who are insufficiently active and highly sedentary. Improved health related quality of life quantified in Health-Adjusted Life Years (HALYs) (based on the health impacts of increased metabolic equivalent (MET) minutes and reduced body mass index (BMI) and cost-offsets (resulting from reductions in obesity and physical inactivity-related diseases) were tracked until the cohort reached age 100 years or death. A 3% discount rate was used and all outcomes were expressed in 2010 values. Simulation modelling techniques were used to present 95% uncertainty intervals around all outputs. RESULTS The within-trial cost-efficacy analysis indicated that the ACHIEVE intervention cost approximately A$77,432. The cost per participant recruited was A$944. The incremental cost-effectiveness ratio (ICER) for MET increase per person per week was A$0.61; minute of sedentary time reduced per participant per day was A$5.15 and BMI unit loss per participant was A$763. The long-term cost effectiveness analysis indicated that if the intervention was scaled-up to all eligible Australians, approximately 265,095 participants would be recruited to the program at an intervention cost of A$107.4 million. Health care cost savings were A$33.4 million. Total HALYs gained were 2,709. The mean ICER was estimated at A$27,297 per HALY gained which is considered cost-effective in the Australian setting. CONCLUSION The study findings suggest that financial incentives to promote physical activity and reduce sedentary behaviour are likely to be cost-effective. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616000158460 (10/02/2016).
Collapse
Affiliation(s)
- Jaimie-Lee Maple
- Institute for Health and Sport, Victoria University, Footscray, Australia. .,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, Australia.
| | - Jaithri Ananthapavan
- Deakin Health Economics, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.,Global Obesity Centre (GLOBE), Faculty of Health, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.,Global Obesity Centre (GLOBE), Faculty of Health, Institute of Health Transformation, Deakin University, Geelong, Australia
| |
Collapse
|
13
|
Bolton KA, Fraser P, Lowe J, Moodie M, Bell C, Strugnell C, Hayward J, McGlashan J, Millar L, Whelan J, Brown A, Allender S. Generating change through collective impact and systems science for childhood obesity prevention: The GenR8 Change case study. PLoS One 2022; 17:e0266654. [PMID: 35544522 PMCID: PMC9094504 DOI: 10.1371/journal.pone.0266654] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Community-based interventions have shown promise in reducing childhood overweight and obesity. However, they have been critiqued for using linear logic models. Participatory community-based systems approaches are posited as addressing the complexity of non-linear relationships in a local context. Community members are empowered to understand and describe obesity causation, identify and prioritise possible solutions. The application of such approaches to childhood obesity is in its infancy. AIM To describe the first 12 months of a participatory whole-of-community systems approach to creating collective action to tackle childhood obesity, called GenR8 Change, in a local government area of Victoria, Australia. METHODS Three group model building (GMB) sessions focused on the development of a causal loop diagram (CLD), prioritised evidence-informed actions, and developed implementation strategies. The collective impact framework underpinned the approach, with a local backbone group supporting community members to implement prioritised actions. RESULTS The first two GMB sessions included 20 key community leaders where a CLD examining the factors contributing to childhood obesity in the community was constructed and refined (22 variables GMB1, 53 variables GMB2). In the third session, 171 members of the wider community further refined the CLD, identified priorities for childhood obesity prevention (72 variables in final CLD). One-hundred and thirteen individuals signed up across 13 working groups to plan and implement 53 prioritised actions. Agreed community actions included creating sugar free zones; developing healthy policies; increasing breastfeeding rates; improving drinking water access; and increasing physical activity options. Twelve months post-GMB3, 115 actions had been implemented. CONCLUSION GenR8 Change is one of the first communities to apply systems thinking to childhood obesity prevention. Knowledge on how to collectively identify relevant leverage points to tackle childhood obesity can now be shared with other communities.
Collapse
Affiliation(s)
- Kristy A. Bolton
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Penny Fraser
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Janette Lowe
- Southern Grampians Glenelg Primary Care Partnership, Hamilton, Victoria, Australia
| | - Marj Moodie
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Josh Hayward
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Jaimie McGlashan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Lynne Millar
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jillian Whelan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Andrew Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
14
|
Cost-Benefit and Cost-Utility Analyses to Demonstrate the Potential Value-for-Money of Supermarket Shelf Tags Promoting Healthier Packaged Products in Australia. Nutrients 2022; 14:nu14091919. [PMID: 35565886 PMCID: PMC9103654 DOI: 10.3390/nu14091919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
The supermarket environment impacts the healthiness of food purchased and consumed. Shelf tags that alert customers to healthier packaged products can improve the healthiness of overall purchases. This study assessed the potential value-for-money of implementing a three-year shelf tag intervention across all major supermarket chains in Australia. Cost-benefit analyses (CBA) and cost-utility analyses (CUA) were conducted based on results of a 12-week non-randomised controlled trial of a shelf tag intervention in seven Australian supermarkets. The change in energy density of all packaged foods purchased during the trial was used to estimate population-level changes in mean daily energy intake. A multi-state, multiple-cohort Markov model estimated the subsequent obesity-related health and healthcare cost outcomes over the lifetime of the 2019 Australian population. The CBA and CUA took societal and healthcare sector perspectives, respectively. The intervention was estimated to produce a mean reduction in population body weight of 1.09 kg. The net present value of the intervention was approximately AUD 17 billion (B). Over 98% of the intervention costs were borne by supermarkets. CUA findings were consistent with the CBA-the intervention was dominant, producing both health benefits and cost-savings. Shelf tags are likely to offer excellent value-for-money from societal and healthcare sector perspectives.
Collapse
|
15
|
A Theory of Change for Community-Based Systems Interventions to Prevent Obesity. Am J Prev Med 2022; 62:786-794. [PMID: 34865936 DOI: 10.1016/j.amepre.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Applying systems science in public health trials is a recent innovation in childhood obesity prevention. This paper aims to use systems science conventions to propose a theory of change for community-based interventions aiming to build capacity and use exemplars from systems science for obesity prevention to describe how this approach works. METHODS Participants were community-based researchers. A dynamic hypothesis was created in workshops conducted in 2020 and 2021 by identifying variables critical to building community capacity for systems thinking. These were used to develop stock and flow diagrams representing individual causal relationships, feedback loops, and the overall theory of change. RESULTS The resultant model identified 9 stocks and 4 pairs of central balancing and reinforcing feedback loops. These represented building commitment through relationships, mutual learning, strengthening collaboration, and embedding capacity. The model is described using examples from 3 trials involving 25 communities across Victoria, Australia. CONCLUSIONS This nonlinear and practice-based model illustrates the process of community-based obesity prevention. The model integrates >20 years of community-based intervention implementation experience, providing an overarching theory of how such interventions work to create change and prevent obesity.
Collapse
|
16
|
Onyimadu O, Violato M, Astbury NM, Jebb SA, Petrou S. Health Economic Aspects of Childhood Excess Weight: A Structured Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:461. [PMID: 35455505 PMCID: PMC9028108 DOI: 10.3390/children9040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.
Collapse
Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK;
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| |
Collapse
|
17
|
Hoelscher DM, Brann LS, O’Brien S, Handu D, Rozga M. Prevention of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews. J Acad Nutr Diet 2022; 122:410-423.e6. [DOI: 10.1016/j.jand.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023]
|
18
|
Ananthapavan J, Moodie M, Milat A, Veerman L, Whittaker E, Carter R. A cost-benefit analysis framework for preventive health interventions to aid decision-making in Australian governments. Health Res Policy Syst 2021; 19:147. [PMID: 34923970 PMCID: PMC8684630 DOI: 10.1186/s12961-021-00796-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/24/2021] [Indexed: 12/30/2022] Open
Abstract
Background Australian governments are increasingly mandating the use of cost–benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a CBA framework for the evaluation of preventive health interventions that balances the need for consistency with other agency guidelines whilst adhering to guidelines and conventions for health economic evaluations. Methods We analysed CBA and other evaluation guidance documents published by Australian federal and New South Wales (NSW) government departments. Data extraction compared the recommendations made by different agencies and the impact on the analysis of preventive health interventions. The framework specifies a reference case and sensitivity analyses based on the following considerations: (1) applied economic evaluation theory; (2) consistency between CBA across different government departments; (3) the ease of moving from a CBA to a more conventional cost-effectiveness/cost-utility analysis framework often used for health interventions; (4) the practicalities of application; and (5) the needs of end users being both Cabinet decision-makers and health policy-makers. Results Nine documents provided CBA or relevant economic evaluation guidance. There were differences in terminology and areas of agreement and disagreement between the guidelines. Disagreement between guidelines involved (1) the community included in the societal perspective; (2) the number of options that should be appraised in ex ante analyses; (3) the appropriate time horizon for interventions with longer economic lives; (4) the theoretical basis and value of the discount rate; (5) parameter values for variables such as the value of a statistical life; and (6) the summary measure for decision-making. Conclusions This paper addresses some of the methodological challenges that have hindered the use of CBA in prevention by outlining a framework that is consistent with treasury department guidelines whilst considering the unique features of prevention policies. The effective use and implementation of a preventive health CBA framework is likely to require considerable investment of time and resources from state and federal government departments of health and treasury but has the potential to improve decision-making related to preventive health policies and programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00796-w.
Collapse
Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia. .,Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.,Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Andrew Milat
- NSW Ministry of Health, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| |
Collapse
|
19
|
Taghizadeh S, Farhangi MA, Khodayari-Zarnaq R. Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study. BMC Public Health 2021; 21:2260. [PMID: 34895191 PMCID: PMC8665716 DOI: 10.1186/s12889-021-12282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders. Methods A qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran. Results The identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents. Conclusion The existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12282-7.
Collapse
Affiliation(s)
- Shahnaz Taghizadeh
- Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, 14711, Tabriz, 5166614711, Iran.
| |
Collapse
|
20
|
Arrospide A, Ibarrondo O, Castilla I, Larrañaga I, Mar J. Development and Validation of a Discrete Event Simulation Model to Evaluate the Cardiovascular Impact of Population Policies for Obesity. Med Decis Making 2021; 42:241-254. [PMID: 34632840 PMCID: PMC8777309 DOI: 10.1177/0272989x211032964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Our aim was to describe the development and validation of an obesity model
representing the cardiovascular risks associated with different body mass
index (BMI) categories, through simulation, designed to evaluate the
epidemiological and economic impact of population policies for obesity. Methods A discrete event simulation model was built in R considering the risk of
cardiovascular events (heart failure, stroke, coronary heart disease, and
diabetes) associated with BMI categories in the Spanish population. The main
parameters included in the model were estimated from Spanish hospital
discharge records and the Spanish Health Survey and allowed both first-order
and second-order (probabilistic sensitivity analysis) uncertainty to be
programmed into the model. The simulation yielded the incidence and
prevalence of cardiovascular events as validation outputs. To illustrate the
capacity of the model, we estimated the reduction in cardiovascular events
and cost-utility (incremental cost/incremental quality-adjusted life-years
[QALYs]) of a hypothetical intervention that fully eliminated the
cardiovascular risks associated with obesity and overweight. Results The Validation Status of Health-Economic decision models (AdViSHE) tool was
applied. Internal validation plots showed adequate goodness of fit for the
Spanish population. External validation was achieved by comparing the
simulated and real incidence by age group for stroke, acute myocardial
infarction, and heart failure. The intervention reduced the population
hazard ratios of stroke, acute myocardial infarction, and heart failure to
0.81, 0.74, and 0.78, respectively, and added 0.74 QALYs to the whole
population. Conclusions This obesity simulation model evidenced good properties for estimating the
long-term epidemiological and economic impact of policies to tackle obesity
in Spain. The conceptual model could be implemented for other counties using
country-specific input data.
Collapse
Affiliation(s)
- Arantzazu Arrospide
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain.,Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain
| | - Iván Castilla
- Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,Department of Informatics and Systems Engineering, University of La Laguna, La Laguna, Islas Canarias, Spain
| | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain.,Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Arrasate-Mondragón, Pais Vasco, Spain.,Biodonostia Health Research Institute, Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Spain.,Kronikgune Institute for Health Services Research, Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| |
Collapse
|
21
|
Allender S, Orellana L, Crooks N, Bolton KA, Fraser P, Brown AD, Le H, Lowe J, de la Haye K, Millar L, Moodie M, Swinburn B, Bell C, Strugnell C. Four-Year Behavioral, Health-Related Quality of Life, and BMI Outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity. Obesity (Silver Spring) 2021; 29:1022-1035. [PMID: 33950583 PMCID: PMC8251751 DOI: 10.1002/oby.23130] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to test the effectiveness of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS Childhood Obesity) for behavioral, health-related quality of life (HRQoL), and BMI outcomes. METHODS This was a cluster randomized trial of 10 communities randomly allocated (1:1) to start intervention in 2015 (step 1) or in 2019 (after 4 years) in South West Victoria, Australia. Data were collected from participating primary schools in April to June of 2015 (73% school participation rate), 2017 (69%), and 2019 (63%). Student participation rates were 80% in 2015 (1,792/2,516 invited), 81% in 2017 (2,411/2,963), and 79% in 2019 (2,177/2,720). Repeat cross-sectional analyses of measured height and weight (grades two, four, and six [aged approximately 7 to 12 years]), self-reported behavior, and HRQoL (grades four and six) were conducted. RESULTS There was an intervention by time interaction in BMI z scores (P = 0.031) and obesity/overweight prevalence (P = 0.006). BMI z score and overweight/obesity prevalence decreased between 2015 and 2017 and increased between 2017 and 2019 in intervention communities. The intervention significantly reduced takeaway food consumption (P = 0.034) and improved physical (P = 0.019), psychosocial (P = 0.026), and global (P = 0.012) HRQoL. Water consumption increased among girls (P = 0.033) in the intervention communities, as did energy-dense, nutrient-poor snack consumption among boys (P = 0.006). CONCLUSIONS WHO STOPS had a positive impact on takeaway food intake and HRQoL.
Collapse
Affiliation(s)
- Steven Allender
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Liliana Orellana
- Faculty of HealthBiostatistics UnitDeakin UniversityGeelongVictoriaAustralia
| | - Nic Crooks
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Kristy A. Bolton
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Penny Fraser
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Andrew Dwight Brown
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Ha Le
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health, Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Janette Lowe
- Southern Grampians and Glenelg Primary Care PartnershipHamiltonVictoriaAustralia
| | - Kayla de la Haye
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Lynne Millar
- School of Public HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Marjorie Moodie
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health, Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Boyd Swinburn
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Colin Bell
- Faculty of Health, School of MedicineDeakin UniversityGeelongVictoriaAustralia
| | - Claudia Strugnell
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| |
Collapse
|
22
|
Rozga M, Handu D. Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2501-2523. [PMID: 33495106 DOI: 10.1016/j.jand.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.
Collapse
|
23
|
Tan EJ, Taylor RW, Taylor BJ, Brown V, Hayes AJ. Cost-Effectiveness of a Novel Sleep Intervention in Infancy to Prevent Overweight in Childhood. Obesity (Silver Spring) 2020; 28:2201-2208. [PMID: 33012118 DOI: 10.1002/oby.22989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine, from a health funder perspective, whether a sleep intervention, delivered in infancy, either alone or in combination with food, activity, and breastfeeding advice was cost-effective compared with usual care. METHODS A cost-effectiveness analysis was conducted alongside the Prevention of Overweight in Infancy (POI) randomized controlled trial for outcomes at 5 years and cost-effectiveness was modeled to age 15 years using the Early Prevention of Obesity in Childhood microsimulation model. Intervention costs for the Sleep (n = 192), Combination (n = 196), and control (n = 209) groups were determined in 2018 Australian dollars. Incremental cost-effectiveness ratios (ICERs) were determined for BMI outcomes at 5 and 15 years, with the primary outcome being quality-adjusted life years (QALYs) modeled over 15 years. RESULTS The average costs of the Sleep and Combination interventions were $184 and $601 per child, respectively. The ICER for the Sleep intervention was $18,125 per QALY gained, with a 74% probability of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY. The ICER for the Combination intervention was $94,667 per QALY gained with a 23% probability of being cost-effective. CONCLUSIONS The POI Sleep intervention, without additional advice, was a low-cost and cost-effective approach to reducing childhood obesity. Sleep modification programs offer a very promising approach to obesity prevention in children.
Collapse
Affiliation(s)
- Eng Joo Tan
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry J Taylor
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Alison J Hayes
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
24
|
Whelan J, Strugnell C, Allender S, Korn AR, Brown AD, Orellana L, Hayward J, Brown V, Bell C, Moodie M, Peeters A, Nichols M. Protocol for the measurement of changes in knowledge and engagement in the stepped wedge cluster randomised trial for childhood obesity prevention in Australia: (Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND)). Trials 2020; 21:763. [PMID: 32887655 PMCID: PMC7650215 DOI: 10.1186/s13063-020-04692-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community leaders within a whole-of-community systems intervention across 10 large intervention communities in Australia. METHODS We will investigate the role of stakeholder knowledge and engagement in the implementation and effectiveness of the stepped wedge cluster randomised trial in ten communities in Victoria, Australia. Data will be collected using the Stakeholder-driven Community Diffusion Survey (SDCD) to measure levels of knowledge and engagement prior to commencement (2019), across the three separate levels of governance within the intervention at five time points. Primary outcomes will be baseline overall knowledge and engagement scores across the three levels of governance and change in overall knowledge and engagement over time. DISCUSSION We hypothesise there will be heterogeneity between intervention sites on levels of knowledge and engagement and that these differences will be associated with variability in implementation success. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001986268 . Registered on 11 December 2018.
Collapse
Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Claudia Strugnell
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Ariella R. Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Andrew D. Brown
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | | | - Josh Hayward
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Vicki Brown
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Marj Moodie
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Melanie Nichols
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| |
Collapse
|
25
|
Ananthapavan J, Sacks G, Brown V, Moodie M, Nguyen P, Veerman L, Mantilla Herrera AM, Lal A, Peeters A, Carter R. Priority-setting for obesity prevention-The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLoS One 2020; 15:e0234804. [PMID: 32559212 PMCID: PMC7304600 DOI: 10.1371/journal.pone.0234804] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multi-state life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability. Implementation of these policies will require sustained co-ordination across jurisdictions and multiple government sectors in order to generate the predicted health benefits for the Australian population.
Collapse
Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Ana Maria Mantilla Herrera
- Queensland Centre for Mental Health Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Anita Lal
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| |
Collapse
|
26
|
Yi ZM, Men P, Qu S, Li C, Yu X, Zhai S. Comparative cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. Expert Rev Pharmacoecon Outcomes Res 2020; 20:313-320. [PMID: 32293194 DOI: 10.1080/14737167.2020.1752670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Both amisulpride and olanzapine are leading treatments for schizophrenia in China. This study aimed to investigate the long-term cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. METHODS A decision-analytic Markov model was developed to simulate the lifetime clinical and economic outcomes of schizophrenia treatment from the healthcare payer perspective. The long-term costs and QALYs were estimated. Sensitivity analyses were performed to explore the impact of variance of parameters on the results. RESULTS Treatment with amisulpride provided an effectiveness gain of 16.59 QALYs at an average cost of USD 25,884 whereas olanzapine resulted in 16.38 QALYs at a cost of USD 34,839 over a lifetime horizon. One-way sensitivity analysis suggested that the most sensitive variable was the unit cost of olanzapine. In a probabilistic sensitivity analysis based on a Monte Carlo simulation with a lifetime horizon, the probability of amisulpride being cost-effective was 99.8% at a willingness-to-pay threshold of USD 9,322, the GDP per capita in China 2018. A scenario analysis with updated olanzapine unit cost suggested an ICER of 7,857 USD/QALY. CONCLUSIONS Amisulpride is likely to be a cost-effective option with increased effectiveness compared with olanzapine in the treatment of schizophrenia patients in China.
Collapse
Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| | - Shuli Qu
- Real-World Insights, IQVIA , Shanghai, China
| | - Chaoyun Li
- Health Economics & Outcome Research, Sanofi , Shanghai, China
| | - Xin Yu
- Department of Psychiatry, Peking University Sixth Hospital , Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| |
Collapse
|
27
|
Lal A, Peeters A, Brown V, Nguyen P, Tran HNQ, Nguyen T, Tonmukayakul U, Sacks G, Calache H, Martin J, Moodie M, Ananthapavan J. The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia. Nutrients 2020; 12:E649. [PMID: 32121199 PMCID: PMC7146305 DOI: 10.3390/nu12030649] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Over one third of Australians' daily energy intake is from discretionary foods and drinks. While many health promotion efforts seek to limit discretionary food intake, the population health impact of reductions in the consumption of different types of discretionary foods (e.g., sugar-sweetened beverages (SSBs), confectionery, sweet biscuits) has not been quantified. This study estimated the potential reductions in body weight, obesity-related disease incidence, and healthcare cost savings associated with consumption of one less serving per week of different discretionary foods. Reductions in the different types of discretionary food were modelled individually to estimate the impact on energy consumption and population body weight by 5-year age and sex groups. It was assumed that one serving of discretionary food each week was replaced with either a serving of fruit or popcorn, and a serving (375 mL) of SSBs was replaced with coffee, tea, or milk. Proportional multi-state multiple-cohort Markov modelling estimated likely resultant health adjusted life years (HALYs) gained and healthcare costs saved over the lifetime of the 2010 Australian population. A reduction of one serving of SSBs (375 mL) had the greatest potential impact in terms of weight reduction, particularly in ages 19-24 years (mean 0.31 kg, 95% UI: 0.23 kg to 0.37 kg) and overall healthcare cost savings of AUD 793.4 million (95% UI: 589.1 M to 976.1 M). A decrease of one serving of sweet biscuits had the second largest potential impact on weight change overall, with healthcare cost savings of $640.7 M (95% CI: $402.6 M to $885.8 M) and the largest potential weight reduction amongst those aged 75 years and over (mean 0.21 kg, 95% UI: 0.14 kg to 0.27 kg). The results demonstrate that small reductions in discretionary food consumption are likely to have substantial health benefits at the population level. Moreover, the study highlights that policy responses to improve population diets may need to be tailored to target different types of foods for different population groups.
Collapse
Affiliation(s)
- Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Phuong Nguyen
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Huong Ngoc Quynh Tran
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Tan Nguyen
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Jane Martin
- Obesity Policy Coalition, Cancer Council Victoria, Melbourne, VIC 3004, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| |
Collapse
|
28
|
Robinson E, Nguyen P, Jiang H, Livingston M, Ananthapavan J, Lal A, Sacks G. Increasing the Price of Alcohol as an Obesity Prevention Measure: The Potential Cost-Effectiveness of Introducing a Uniform Volumetric Tax and a Minimum Floor Price on Alcohol in Australia. Nutrients 2020; 12:E603. [PMID: 32110864 PMCID: PMC7146351 DOI: 10.3390/nu12030603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to estimate, from an obesity prevention perspective, the cost-effectiveness of two potential policies that increase the price of alcohol in Australia: a volumetric tax applied to all alcohol (Intervention 1) and a minimum unit floor price (Intervention 2). Estimated changes in alcoholic drink consumption and corresponding changes in energy intake were calculated using the 2011-12 Australian Health Survey data, published price elasticities, and nutrition information. The incremental changes in body mass index (BMI), BMI-related disease outcomes, healthcare costs, and Health Adjusted Life Years (HALYs) were estimated using a validated model. Costs associated with each intervention were estimated for government and industry. Both interventions were estimated to lead to reductions in mean alcohol consumption (Intervention 1: 20.7% (95% Uncertainty Interval (UI): 20.2% to 21.1%); Intervention 2: 9.2% (95% UI: 8.9% to 9.6%); reductions in mean population body weight (Intervention 1: 0.9 kg (95% UI: 0.84 to 0.96); Intervention 2: 0.45 kg (95% UI: 0.42 to 0.48)); HALYs gained (Intervention 1: 566,648 (95% UI: 497,431 to 647,262); Intervention 2: 317,653 (95% UI: 276,334 to 361,573)); and healthcare cost savings (Intervention 1: $5.8 billion (B) (95% UI: $5.1B to $6.6B); Intervention 2: $3.3B (95% UI: $2.9B to $3.7B)). Intervention costs were estimated as $24M for Intervention 1 and $30M for Intervention 2. Both interventions were dominant, resulting in health gains and cost savings. Increasing the price of alcohol is likely to be cost-effective from an obesity prevention perspective in the Australian context, provided consumers substitute alcoholic beverages with low or no kilojoule alternatives.
Collapse
Affiliation(s)
- Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
| | - Phuong Nguyen
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Heng Jiang
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia; (H.J.); (M.L.)
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton VIC 3053, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia; (H.J.); (M.L.)
| | - Jaithri Ananthapavan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Anita Lal
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
| |
Collapse
|
29
|
Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia. Int J Behav Nutr Phys Act 2019; 16:89. [PMID: 31640737 PMCID: PMC6805526 DOI: 10.1186/s12966-019-0853-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia. METHODS Baseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20-74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements. RESULTS Multi-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse). CONCLUSIONS Based on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.
Collapse
|
30
|
A Community Bundle to Lower School-Aged Obesity Rates in a Small Midwestern City. REPORTS 2019. [DOI: 10.3390/reports2030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Multi-component interventions in large communities such as Philadelphia can effectively lower childhood obesity rates. It is less clear whether this type of intervention can be successful in smaller communities with more limited resources. Norwood, Ohio is a small Midwestern city with a population of 19,207. In 2010, Ohio passed a school health law requiring Body Mass Index (BMI) screening of students in kindergarten and grades 3, 5 and 9 along with restrictions on competitive foods and vending machine products and a physical education requirement of 30 min per day. In 2014, Norwood implemented a multi-component childhood obesity prevention and treatment bundle of interventions. Our objective was to describe the effects if this bundle on childhood overweight/obesity (OW/OB) rates. We hypothesized that implementation of the bundle would lower the prevalence of OW/OB in Norwood school children. Methods: In 2012, the Healthy Kids Ohio Act was fully implemented in the Norwood City School District (NCSD). In 2014 a comprehensive bundle was implemented that included: 1. A student gardening program; 2. Supplementation of fresh produce to a local food pantry and a family shelter; 3. A farmers market; 4. A health newsletter; 5. Incentives in the school cafeterias to promote healthy food selection; 6. A 100-mile walking club; 7. “Cook for America” (a “cooked from scratch” intervention for school cafeterias); 8. A school-based obesity treatment clinic; Results: The OW/OB rate in the NCSD was 43% at the time of the Bundle implementation in 2014 and 37% in 2016 (p = 0.029). Conclusions: A childhood OW/OB prevention bundle can be implemented in a small city and is associated with a favorable change in BMI.
Collapse
|